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      Help from home for depression: A randomised controlled trial comparing internet-delivered cognitive behaviour therapy with bibliotherapy for depression

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          Abstract

          Major Depressive Disorder (MDD) is a leading cause of the Global Burden of Disease. Cognitive Behavioural Therapy (CBT) is an effective treatment for MDD, but access can be impaired due to numerous barriers. Internet-delivered CBT (iCBT) can be utilised to overcome treatment barriers and is an effective treatment for depression, but has never been compared to bibliotherapy. This Randomised Controlled Trial (RCT) included participants meeting diagnostic criteria for MDD ( n = 270) being randomised to either: iCBT ( n = 61), a CBT self-help book (bCBT) ( n = 77), a meditation self-help book (bMED) ( n = 64) or wait-list control (WLC) ( n = 68). The primary outcome was the Patient Health Questionnaire 9-item scale (PHQ-9) at 12-weeks (post-treatment). All three active interventions were significantly more effective than WLC in reducing depression at post-treatment, but there were no significant differences between the groups. All three interventions led to large within-group reductions in PHQ-9 scores at post-treatment ( g  = 0.88–1.69), which were maintained at 3-month follow-up, although there was some evidence of relapse in the bMED group (within-group g [post to follow-up]  = 0.09–1.04). Self-help based interventions could be beneficial in treating depression, however vigilance needs to be applied when selecting from the range of materials available. Replication of this study with a larger sample is required.

          Highlights

          • •

            Depression is prevalent with access to treatment impaired by numerous factors.

          • •

            This novel RCT compared guided internet-delivered CBT with an unguided CBT book and an unguided meditation book.

          • •

            All three interventions were more effective in reducing depression than wait-list control at post-treatment.

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            No significant differences existed between the intervention groups at post-treatment.

          • •

            Self-help treatments could be utilised for depression treatment but vigilance and monitoring needs to be applied.

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          Most cited references27

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          Global burden of depressive disorders in the year 2000.

          T Ustün, J Ayuso-Mateos, S Chatterji … (2004)
          The initial Global Burden of Disease study found that depression was the fourth leading cause of disease burden, accounting for 3.7% of total disability adjusted life years (DALYs) in the world in 1990. To present the new estimates of depression burden for the year 2000. DALYs for depressive disorders in each world region were calculated, based on new estimates of mortality, prevalence, incidence, average age at onset, duration and disability severity. Depression is the fourth leading cause of disease burden, accounting for 4.4% of total DALYs in the year 2000, and it causes the largest amount of non-fatal burden, accounting for almost 12% of all total years lived with disability worldwide. These data on the burden of depression worldwide represent a major public health problem that affects patients and society.
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            Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness.

            Erik Hedman, Brjánn Ljótsson, Nils Lindefors (2012)
            Internet-based cognitive behavior therapy (ICBT) is a promising treatment that may increase availability of cognitive behavior therapy (CBT) for psychiatric disorders and other clinical problems. The main objective of this study was to determine the applications, clinical efficacy and cost-effectiveness of ICBT. The authors conducted a systematic review to identify randomized controlled trials investigating CBT delivered via the internet for adult patient populations. Searches to identify studies investigating cost-effectiveness of ICBT were also conducted. Evidence status for each clinical application was determined using the American Psychologist Association criteria for empirically supported treatments. Of 1104 studies reviewed, 108 met criteria for inclusion, of which 103 reported on clinical efficacy and eight on cost-effectiveness. Results showed that ICBT has been tested for 25 different clinical disorders, whereas most randomized controlled trials have been aimed at depression, anxiety disorders and chronic pain. Internet-based treatments for depression, social phobia and panic disorder were classified as well-established, that is, meeting the highest level of criteria for evidence. Effect sizes were large in the treatment of depression, anxiety disorders, severe health anxiety, irritable bowel syndrome, female sexual dysfunction, eating disorders, cannabis use and pathological gambling. For other clinical problems, effect sizes were small to moderate. Comparison to conventional CBT showed that ICBT produces equivalent effects. Cost-effectiveness data were relatively scarce but suggested that ICBT has more than 50% probability of being cost effective compared with no treatment or to conventional CBT when willingness to pay for an additional improvement is zero. Although ICBT is a promising treatment option for several disorders, it can only be regarded as a well-established treatment for depression, panic disorder and social phobia. It seems that ICBT is as effective as conventional CBT for respective clinical disorder, that is, if conventional CBT works then ICBT works. The large effects and the limited therapist time required suggest that the treatment is highly cost effective for well-established indications.
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              Internet-based self-help for depression: randomised controlled trial.

              Gerhard Andersson, Jan Bergström, Fredrik Holländare … (2005)
              Major depression can be treated by means of cognitive-behavioural therapy, but as skilled therapists are in short supply there is a need for self-help approaches. Many individuals with depression use the internet for discussion of symptoms and to share their experience. To investigate the effects of an internet-administered self-help programme including participation in a monitored, web-based discussion group, compared with participation in web-based discussion group only. A randomised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact (plus participation in a discussion group) with the effects of participation in a discussion group only. Internet-based therapy with minimal therapist contact, combined with activity in a discussion group, resulted in greater reductions of depressive symptoms compared with activity in a discussion group only (waiting-list control group). At 6 months' follow-up, improvement was maintained to a large extent. Internet-delivered cognitive cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression.
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                Author and article information

                Contributors
                Jill M. Newby
                Journal
                Journal ID (nlm-ta): Internet Interv
                Journal ID (iso-abbrev): Internet Interv
                Title: Internet Interventions
                Publisher: Elsevier
                ISSN (Electronic): 2214-7829
                Publication date PMC-release: 18 May 2017
                Publication date Collection: September 2017
                Publication date (Electronic): 18 May 2017
                Volume: 9
                Pages: 25-37
                Affiliations
                [a ]Clinical Research Unit for Anxiety and Depression (CRUfAD), University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
                [b ]School of Psychology, University of New South Wales, Australia
                [c ]Department of Social and Behavioural Sciences, Utrecht University, the Netherlands
                Author notes
                [* ]Corresponding author at: School of Psychology, 1302 Mathews Building, University of New South Wales, Kensington, NSW 2052, Australia. j.newby@ 123456unsw.edu.au
                Article
                Publisher ID: S2214-7829(17)30022-2
                DOI: 10.1016/j.invent.2017.05.001
                PMC ID: 6096313
                PubMed ID: 30135834
                SO-VID: 322a4b6e-35f9-42dd-8b6f-0638ccf28d92
                Copyright © © 2017 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 20 February 2017
                Date revision received : 3 May 2017
                Date accepted : 15 May 2017
                Categories
                Subject: Full length Article

                Keywords: depression,internet-delivered cognitive behavioural therapy,bibliotherapy
                Data availability:
                Keywords: depression, internet-delivered cognitive behavioural therapy, bibliotherapy

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